Development of Ceftazidime Resistance in Burkhoderia pseudomallei in a Patient Experiencing Melioidosis with Mediastinal Lymphadenitis

Kung, Chia Te; Lee, Chen Hsiang; Li, Chao Jui; Lu, Hung I.; Ko, Sheung Fat; Liu, Jien Wei

doi:10.47102/annals-acadmedsg.v39n12p945

Cited by 13 publications

(2 citation statements)

References 9 publications

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“…However, B. pseudomallei has been reported to develop acquired antibiotic resistance in vivo during treatment, which can be fatal if treatment is not shifted to alternative drugs in due course [ 119 ]. Considering that ceftazidime is commonly used as a first-line agent in the acute phase, resistance had been observed during treatments [ 56 , 64 , 120 ]. This was often conferred by mutations in the penA gene encoding class A β-lactamase, resulting in altered substrate specificity [ 60 , 121 ].…”

Section: Antibiotics Vs Phage Therapymentioning

confidence: 99%

Effective Therapeutic Options for Melioidosis: Antibiotics versus Phage Therapy

et al. 2022

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Melioidosis, also known as Whitmore’s disease, is a potentially fatal infection caused by the Gram-negative bacteria Burkholderia pseudomallei with a mortality rate of 10–50%. The condition is a “glanders-like” illness prevalent in Southeast Asian and Northern Australian regions and can affect humans, animals, and sometimes plants. Melioidosis received the epithet “the great mimicker” owing to its vast spectrum of non-specific clinical manifestations, such as localised abscesses, septicaemia, pneumonia, septic arthritis, osteomyelitis, and encephalomyelitis, which often lead to misdiagnosis and ineffective treatment. To date, antibiotics remain the backbone of melioidosis treatment, which includes intravenous therapy with ceftazidime or meropenem, followed by oral therapy with TMP-SMX or amoxicillin/clavulanic acid and supported by adjunctive treatment. However, bacteria have developed resistance to a series of antibiotics, including clinically significant ones, during treatment. Therefore, phage therapy has gained unprecedented interest and has been proposed as an alternative treatment. Although no effective phage therapy has been published, the findings of experimental phage therapies suggest that the concept could be feasible. This article reviews the benefits and limitations of antibiotics and phage therapy in terms of established regimens, bacterial resistance, host specificity, and biofilm degradation.

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Section: Antibiotics Vs Phage Therapymentioning

confidence: 99%

Effective Therapeutic Options for Melioidosis: Antibiotics versus Phage Therapy

et al. 2022

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“…There are sporadic reports of the emergence of resistance to ceftazidime as well as carbapenems, mostly during treatment and occasional reports of de novo resistance to these drugs, from various endemic countries including India. 3 4 5 6 7 Resistance to ceftazidime can be mediated by upregulation or amino acid substitution of the β-lactamase-encoding gene penA or the deletion of penicillin-binding protein 3 (PBP3). 2 Mutations in the multidrug resistance-nodulation-division efflux pump regulators often account for decreased meropenem susceptibility.…”

Section: Introductionmentioning

confidence: 99%

In Vitro Susceptibility of Burkholderia pseudomallei Isolates to Cefiderocol and Ceftazidime/Avibactam from Odisha, India

et al. 2023

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Background and Objectives The availability of a limited arsenal of antibacterial agents effective against Burkholderia pseudomallei, the causative agent of melioidosis, together with sporadic reports of emergence of resistance necessitates an evaluation of in vitro activity of new antimicrobials against clinical B. pseudomallei isolates. Cefiderocol (CFDC), a novel siderophore cephalosporin, and ceftazidime-avibactam (CZA), a new β lactam combination agent, have shown promising results for the treatment of difficult-to-treat Gram-negative bacilli infections with limited treatment options. This study was conducted to determine the in vitro activity of CFDC and CZA against a contemporary collection of 60 B. pseudomallei clinical isolates. Materials and Methods Minimum inhibitory concentrations (MIC) of CFDC and CZA were determined by broth microdilution and E-test, respectively. The performance of disk diffusion was also evaluated for CFDC. Results All B. pseudomallei isolates were susceptible to CFDC and CZA with MIC range of 0.125 to 2 mg/L and 0.19 to 1 mg/L, respectively. Zone diameters for CFDC ranged from 31 to 40 mm. Conclusion CFDC and CZA exhibited excellent in vitro activity against 60 B. pseudomallei isolates. Further pharmacokinetic-pharmacodynamics studies and clinical trials are needed to prove the clinical efficacy of CFDC and CZA in the treatment of melioidosis.

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Treatment and prophylaxis of melioidosis

Dance

2014

International Journal of Antimicrobial Agents

240

257

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Melioidosis, infection with Burkholderia pseudomallei, is being recognised with increasing frequency and is probably more common than currently appreciated. Treatment recommendations are based on a series of clinical trials conducted in Thailand over the past 25 years. Treatment is usually divided into two phases: in the first, or acute phase, parenteral drugs are given for ≥10 days with the aim of preventing death from overwhelming sepsis; in the second, or eradication phase, oral drugs are given, usually to complete a total of 20 weeks, with the aim of preventing relapse. Specific treatment for individual patients needs to be tailored according to clinical manifestations and response, and there remain many unanswered questions. Some patients with very mild infections can probably be cured by oral agents alone. Ceftazidime is the mainstay of acute-phase treatment, with carbapenems reserved for severe infections or treatment failures and amoxicillin/clavulanic acid (co-amoxiclav) as second-line therapy. Trimethoprim/sulfamethoxazole (co-trimoxazole) is preferred for the eradication phase, with the alternative of co-amoxiclav. In addition, the best available supportive care is needed, along with drainage of abscesses whenever possible. Treatment for melioidosis is unaffordable for many in endemic areas of the developing world, but the relative costs have reduced over the past decade. Unfortunately there is no likelihood of any new or cheaper options becoming available in the immediate future. Recommendations for prophylaxis following exposure to B. pseudomallei have been made, but the evidence suggests that they would probably only delay rather than prevent the development of infection.

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Development of Ceftazidime Resistance in Burkhoderia pseudomallei in a Patient Experiencing Melioidosis with Mediastinal Lymphadenitis

Cited by 13 publications

References 9 publications

Effective Therapeutic Options for Melioidosis: Antibiotics versus Phage Therapy

Effective Therapeutic Options for Melioidosis: Antibiotics versus Phage Therapy

In Vitro Susceptibility of Burkholderia pseudomallei Isolates to Cefiderocol and Ceftazidime/Avibactam from Odisha, India

Treatment and prophylaxis of melioidosis

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